Azoicăi Tudor, Belibou Ioana Mădălina, Lozneanu Ludmila, Giuşcă Simona Eliza, Cojocaru Elena, Căruntu Irina Draga
Department of Morphofunctional Sciences - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania;
Rom J Morphol Embryol. 2017;58(1):73-78.
Systemic lupus erythematosus (SLE) is characterized by a multifaceted pathogenesis and a heterogeneous clinical expression. The kidney involvement is almost unavoidable in all forms of SLE with chronic evolution, 75% of patients developing renal lesions defined as lupus nephritis (LN) - a glomerulonephritis with an extremely diverse lesion spectrum. The present study aimed to reevaluate a series of cases diagnosed as LN, focusing on the histological features in correlation with the level of activity and chronicity. The study group comprised 46 patients. The specimens obtained through percutaneous needle biopsies were processed for light microscopy and immunofluorescence exams. The reevaluation process focused on the major morphological parameters ensuring: (i) a detailed description of the lesions, (ii) the class diagnosis in accordance with the International Society of Nephrology÷Renal Pathology Society (ISN÷RPS) classification, (iii) the activity and chronicity indexes. In 39 out of the total of 46 (84.78%) cases, the class of LN established at the time of the renal biopsy was confirmed in the reevaluation process. The differences in diagnosis were present in seven cases, initially considered as pure membranous glomerulonephritis - class V. The values of indexes indicated a great variability of LN within the same class. The interobserver agreement for the scoring of activity and chronicity indexes was 0.8 and 0.95, respectively. Our study emphasizes the complex lesion character, which requires an individual and accurate identification, followed by integration in the classification algorithm used to define the classes and subclasses of LN diagnosis. The degree of activity and chronicity in SLE must be refined through a much more precise correspondence between the score value and the limitation or extension of corpuscular and interstitial lesions.
系统性红斑狼疮（SLE）具有多方面的发病机制和异质性的临床表现。在所有慢性进展型的SLE中，肾脏受累几乎不可避免，75%的患者会出现被定义为狼疮性肾炎（LN）的肾脏病变——一种具有极其多样病变谱的肾小球肾炎。本研究旨在重新评估一系列诊断为LN的病例，重点关注与活动度和慢性化程度相关的组织学特征。研究组包括46例患者。通过经皮肾穿刺活检获取的标本进行光镜和免疫荧光检查。重新评估过程聚焦于确保以下主要形态学参数：（i）对病变的详细描述，（ii）根据国际肾脏病学会÷肾脏病理学会（ISN÷RPS）分类进行的分型诊断，（iii）活动度和慢性化指数。在46例病例中的39例（84.78%）中，肾活检时确定的LN分型在重新评估过程中得到了确认。7例病例存在诊断差异，最初被认为是单纯膜性肾小球肾炎——V型。指数值表明同一类型内的LN具有很大变异性。观察者间对活动度和慢性化指数评分的一致性分别为0.8和0.95。我们的研究强调了病变特征的复杂性，这需要个体化且准确的识别，随后整合到用于定义LN诊断的类型和亚类的分类算法中。SLE的活动度和慢性化程度必须通过评分值与肾小球和间质病变的局限或扩展之间更精确的对应关系来细化。
